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The Intersection of Traumatic Brain Injury, Domestic Violence, and Incarceration

Written by: Catherine Guerrero, Principal, Health Management Associates & Pam Clifton, Communication Coordinator, Colorado Criminal Justice Reform Coalition

Over the last decade a focus on brain injury and concussion related to sporting activities and military service has gained popular attention. Only recently, have we also begun to talk about the prevalence of brain injury in relation to domestic violence (DV). A traumatic brain injury (TBI) is one that affects the normal functioning of the brain, and can result in negative consequences to physical, emotional, and cognitive health. TBIs can be difficult to detect, and multiple TBIs, potentially caused by a pattern of physical assault, can have compounding impacts on the life and health of a survivor of domestic violence.

In fact, survivors of domestic violence are at increased risk of brain injury through multiple mechanisms. This risk includes injuries that result from direct trauma to the head and neck, as well as injuries caused by a lack of oxygen to the brain resulting from strangulation.[1] Research estimates that between half and 90% of all individuals who seek medical treatment, and as many as 75% of women seeking services related to domestic violence victimization, display symptoms of brain injury. ^[2],[3]  

The Centers for Disease Control and Prevention (CDC) estimates that one in four women in the United States will experience domestic violence in her lifetime. These experiences of violence greatly increase the chances of experiencing a TBI and suffering the negative outcomes of both the injury and the violence itself. Clearly, TBI should be a significant focus of the work of domestic violence practitioners and medical personnel when working with women known, or suspected, to have experienced domestic violence.

Medical and community service settings are not the only places where we see the need to address the intersection of DV and TBI, however. We know from research that most female defendants involved in the criminal justice system are survivors of abuse, with some estimates suggesting 90% have experienced domestic violence.[4] Not surprisingly, high percentage of incarcerated women also show signs and symptoms of TBI. It is important to note that many of these injuries were sustained before the first criminal offense, and likely contribute to the risk of incarceration.[5] Violence-related TBIs, are in fact, related to higher rates of  physical illness and increased incarceration times among incarcerated women.[6]

Given this background, the opportunity to understand and address the role of TBI in criminality and criminal convictions should be a priority for researchers and advocates alike. Additionally, understanding the ways TBI can complicate reentry and increase the risk for re-incarceration is essential for communities working to reintegrate women transitioning out of jail and prison, and address the ballooning population of women in the criminal justice system.

Over the past 40 years the prison population in the U.S. has increased exponentially, and the rate of female incarceration is growing at twice the rate of men.[7]  Until very recently, we have seen very little trauma or gender responsiveness within prison programming.

Two groundbreaking programs in Colorado are pushing for more change and shining a light on the prevalence and impact of TBI within the population of justice-involved women. In October of 2019, the Colorado Criminal Justice Reform Coalition (CCJRC) decided to take a deeper look at potential drivers of the rising rates of incarceration of women and launched the StrongHer campaign to highlight the fact that many women were victims long before they were defendants. 

In addition to public education, CCJRC has partnered with the Latino Coalition for Community Leadership to support the Work and Gain Employment and Education Skills (WAGEES) program. WAGEES is designed to create a focus on re-entry paired with services and support for prior victimization and trauma in a way that more directly addresses the challenges that women experience.  In Denver, the program provides a psychiatrist who meets with women prior to their release to ensure they are supported and connected to appropriate services. Once released, a local clinic provides care management for health needs as well as housing, employment, and other concerns.

It is clear that women face a variety of challenges when released from prison or jail. This is particularly true with respect to mental and physical health, reengaging family relationships and responsibilities, and a lack of job training and employment opportunities.  The long-lasting impacts of past trauma and potential TBI further complicates the chances for a successful re-entry process.  Effective coordination of services and resources that address the compounding implications of surviving violence and managing TBI is a must. Improving the responses of advocates, medical professionals, and mental health experts to better identify signs and symptoms of a TBI and respond accordingly, can decrease the risk of incarceration for victims of abuse, increase successful re-entry outcomes for women, and enhance public safety for all communities.